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      A study to compare maternal and perinatal outcome in early vs. late onset preeclampsia

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          Abstract

          Objective

          The risk factors, clinical trends, and maternal and fetal health of early- and late-onset preeclampsia have not been adequately studied. We examined the effects of early- and late-onset preeclampsia on maternal and perinatal outcomes as well as the known risk factors of preeclampsia.

          Methods

          One hundred and fifty women with preeclampsia were consecutively enrolled in each group. Those who developed preeclampsia before 34 weeks of gestation were identified as having early-onset preeclampsia, while those who developed at 34 weeks or later were identified as having late-onset preeclampsia. Maternal and perinatal outcomes were compared between groups.

          Results

          Compared with the late-onset group, the early-onset group had higher rates of abruptio placentae (16% vs. 7.3%; P=0.019), but there was no intergroup difference in the composite maternal outcomes. A significantly higher number of women with early-onset preeclampsia developed severe features during the disease course, and most required treatment with antihypertensive drugs. Late-onset preeclampsia was more prevalent among primigravid mothers. Babies born to mothers with early-onset preeclampsia had a significantly higher rate of adverse outcomes.

          Conclusion

          These study findings indicate that women with early-onset preeclampsia had more adverse outcome than those with late-onset preeclampsia, but the difference was not statistically significant. There were more babies with adverse perinatal outcomes in the early-than late-onset group.

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          Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.

          Sarka Lisonkova, K Joseph (2013)
          The population-based incidence of early-onset (<34 weeks) and late-onset preeclampsia (≥34 weeks) has not been adequately studied. We examined the gestational age-specific incidence of preeclampsia onset and identified the associated risk factors and birth outcomes. All singleton deliveries in Washington State, 2003-2008 (n = 456,668), were included, and preeclampsia onset was determined from hospital records linked to birth certificates. Cox and logistic regression models were used to obtain adjusted hazard ratios and odds ratios (AORs) for risk factors and birth outcomes, respectively. The overall preeclampsia rate was 3.1% and the incidence increased sharply with gestation; early- and late-onset preeclampsia rates were 0.38% and 2.72%, respectively. Among women with early-onset preeclampsia, 12% delivered at a gestation of 34 weeks or longer. Risk/protective factors common to both diseases included older maternal age, Hispanic and Native-American race, smoking, unmarried status, and male fetus. African-American race, chronic hypertension, and congenital anomalies were more strongly associated with early-onset preeclampsia, whereas younger maternal age, nulliparity, and diabetes mellitus were more strongly associated with late-onset disease. Early- but not late-onset preeclampsia conferred a high risk of fetal death (AOR, 5.8; 95% confidence interval [CI], 4.0-8.3 vs AOR, 1.3; 95% CI, 0.8-2.0, respectively). The AOR for perinatal death/severe neonatal morbidity was 16.4 (95% CI, 14.5-18.6) in early-onset and 2.0 (95% CI, 1.8-2.3) in late-onset preeclampsia. Early- and late-onset preeclampsia shares some etiological features, differ with regard to several risk factors, and lead to different outcomes. The 2 preeclampsia types should be treated as distinct entities from an etiological and prognostic standpoint. Copyright © 2013 Mosby, Inc. All rights reserved.
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            Subclassification of preeclampsia.

            Peter von Dadelszen, Laura Magee, James Roberts (2003)
            Preeclampsia is a heterogeneous disorder, and as with other diseases (e.g., type I and type II diabetes), progress in the understanding of this disorder would be assisted greatly if subtypes could be characterized. We suggest that a first step would be to subdivide preeclampsia into early-onset disease ( 34 + 0 weeks').
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              Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease.

              Barbara Vasapollo, Herbert Valensise, G. Gagliardi … (2008)
              Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early ( or=34 weeks gestation) PE (blood pressure >140/90+proteinuria >300 mg/dL) to detect possible early differences in the hemodynamic state. A group of 1345 nulliparous normotensive asymptomatic women underwent at 24 weeks gestation uterine artery Doppler evaluation and maternal echocardiography calculating total vascular resistance. In the subsequent follow-up 107 patients showed PE: 32 patients had late and 75 had early PE. Five of 32 patients with late PE and 45 of 75 patients with early PE had bilateral notching of the uterine artery at 24 weeks (15.6% versus 60.0%; P<0.05). Total vascular resistance was 1605+/-248 versus 739+/-244 dyn . s . cm(-5), and cardiac output was 4.49+/-1.09 versus 8.96+/-1.83 L in early versus late PE (P<0.001). Prepregnancy body mass index was higher in late versus early PE (28+/-6 versus 24+/-2 kg/m(2); P<0.001). Early and late PE appear to develop from different hemodynamic states. Late PE appears to be more frequent in patients with high body mass index and low total vascular resistance; earlier forms of PE appear to be more frequent in patients with lower BMI and with bilateral notching of the uterine artery. These findings support the hypothesis of different hemodynamics and origins for early PE (placental mediated, linked to defective trophoblast invasion with high percentage of altered uterine artery Doppler) and late PE (linked to constitutional factors such as high body mass index).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Obstet Gynecol Sci
                Journal ID (iso-abbrev): Obstet Gynecol Sci
                Journal ID (publisher-id): OGS
                Title: Obstetrics & Gynecology Science
                Publisher: Korean Society of Obstetrics and Gynecology; Korean Society of Contraception and Reproductive Health; Korean Society of Gynecologic Endocrinology; Korean Society of Gynecologic Endoscopy and Minimal Invasive Surgery; Korean Society of Maternal Fetal Medicine; Korean Society of Ultrasound in Obstetrics and Gynecology; Korean Urogynecologic Society
                ISSN (Print): 2287-8572
                ISSN (Electronic): 2287-8580
                Publication date (Print): May 2020
                Publication date (Electronic): 03 April 2020
                Volume: 63
                Issue: 3
                Pages: 270-277
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
                [2 ]Department of Neonatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
                Author notes
                Correspondence to Pradip Kumar Saha, MD, MAMS, FIMSA. Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. pradiplekha@ 123456yahoo.co.in
                Author information
                https://orcid.org/0000-0002-3200-4124
                Article
                DOI: 10.5468/ogs.2020.63.3.270
                PMC ID: 7231936
                PubMed ID: 32489971
                SO-VID: 2d3216ef-8f20-4868-a356-8206614b0e31
                Copyright © Copyright © 2020 Korean Society of Obstetrics and Gynecology
                License:

                Articles published in Obstet Gynecol Sci are open-access, distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 August 2019
                Date revision received : 21 October 2019
                Date accepted : 07 November 2019
                Categories
                Subject: Original Article
                Subject: Maternal-Fetal Medicine

                Keywords: early-onset preeclampsia,late onset preeclampsia,maternal outcome,perinatal outcome
                Data availability:
                Keywords: early-onset preeclampsia, late onset preeclampsia, maternal outcome, perinatal outcome

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